Chapter 11

Question 1

What are some examples of body functions and their structures?

Answer 1

Mental functions [structures of the nervous system]
Sensory functions and pain [eye, ear and related structures]
Neuromusculoskeletal and movement-related functions [structures related to movement]
Voice and speech functions [structures related to voice and speech]
Functions and [structures] of the cardiovascular, haematological, immunological and respiratory systems

Question 2

What are some examples of different activities and participation?

Answer 2

Learning and applying knowledge 
General tasks and demands 
Communication 
Movement 
Self care 
Domestic life areas 
Major life areas 
Interpersonal interactions 
Community, social and civic life

Question 3

What are some examples of various environmental factors?

Answer 3

Natural environment
Human-made changes to the environment 
Support and relationships 
Attitudes 
Services, systems and policies 
Products and technology

Question 4

T/F Balance can be examined by one test.

Answer 4

False

Question 5

What are self efficacy scales?

Answer 5

Questionnaires on confidence in doing certain ADLs

Question 6

What are two self efficacy scales often used in clinics?

Answer 6

Activity-specific Balance Confidence Scale (ABC)

Falls Efficacy Scale (FES)

Question 7

What are the instructions for the TUG?

Answer 7

Stand up, walk 3 m (10 ft), turn around, return and sit in chair

Question 8

What do the TUG results indicate?

Answer 8

10 = freely independent
20 = independent in basic transfers
20-29 = gray zone
>30 = need help with chair/toilet transfers, in/out tub, assistance with stairs, unable to go out alone

Question 9

Who is the TUG indicated for?

Answer 9

Sensitive and specific indicator for falls in community dwelling older adults (>15)

Question 10

What is the functional reach test (FRT) used for?

Answer 10

Quick screen for balance problems and risk for falls in older adults

Question 11

What is the Performance Oriented Mobility Assessment used for? What are the subscales/point totals?

Answer 11

Used for frail elderly

Balance subscale = 9 items, 16 points
Gait subscale = 7 items, 12 points
MAX TOAL = 28 points

Question 12

What do POMA scores indicate?

Answer 12

<19 = high risk
19-24 = moderate risk
24-28 = low risk

Question 13

Who is the Berg Balance Test indicated for?

Answer 13

Community dwelling older adults

Question 14

How many items are on the Berg Balance Test? What do the scores mean?

Answer 14

14 items, each on a (0-4) scale

> 32 = 100% risk of falls
decreases from there, at 10% with 56 points

Question 15

What is the Short Physical Performance Battery used for?

Answer 15

Measures LE performance (strength, balance, mobility) in older adults

Question 16

Who developed the BESTest and what does it look at?

Answer 16

Balance Evaluation Systems Test

By Horak in 2009, examines multiple aspects of postural control, 36 items in 6 systems

Question 17

What are the 6 systems of the BESTest?

Answer 17

1 = biomechanical constraints
2 = stability limits
3 = anticipatory-transitions
4 = postural responses
5 = sensory organization
6 = dynamic gait

Question 18

What postural alignment strategies are used to maintain balance?

Answer 18

posture, weight bearing, width of BOS, location of COP

Question 19

What are automatic postural responses?

Answer 19

Keep the COG over the BOS in response to a stimulus or unexpected perturbation. They are rapid and involuntary

Question 20

What are some examples of automatic postural responses?

Answer 20

Ankle, hip, stepping strategies
Adaptive postural responses
Reactive postural responses

Question 21

How do you test reactive control?

Answer 21

Nudge Test (POMA #6) = unexpected external perturbation at sternum, pt has feet as close together as possible, PT pushes lightly 3 times

Question 22

What are the scores for the Nudge Test?

Answer 22

0 = begins to fall
1 = staggers, grabs, catches self
2 = steady

Question 23

How can you examine proactive postural responses?

Answer 23

Have pt lift a heavy grocery bag

Question 24

What motor problems are examined?

Answer 24

Motor coordination
Muscle strength, power
Involuntary movements

Question 25

What cognitive status aspects are examined?

Answer 25

``` Alertness Memory Orientation Attention Learning ```

Question 26

What sensory/perceptual status aspects are examined?

Answer 26

Somatosensory problem Visual problem Vestibular problem Impaired body image and spatial relationship

Question 27

What is the ultimate goal of task-oriented balance rehab?

Answer 27

To improve participation outcomes, reflected in ability to participate in social roles, tasks and activities important in ADLs

Question 28

How can you progress sitting balance?

Answer 28

Progressively less surface contact - Remove UE support - Make surface less stable - Add UE activities - Increase limits of stability through reaching and throwing activities

Question 29

What are some ways to improve control of COG in standing?

Answer 29

``` Slow weight shifts Elastic band LE exercise Standing sway Sit to stand Tai Chi Add UE activities ```

Question 30

What are some exercises to promote ankle strategy?

Answer 30

Standing sway exercise Slow small perturbations either self generated or external Computerized limits of stability training Increase difficulty with UE, head or eye movements Functional activities Increase difficulty with resistance

Question 31

What are some exercises to promote hip strategy?

Answer 31

Standing sway using a table and a wall, patient instructed to bow to move nose towards the table Standing on a rail, add UE activities as able Use moderate rapid perturbations either self generated or external Tandem standing (sharpened Romberg) or walking Single limb support Large anterior/posterior weight shifts on a variety of surfaces Functional activities (reaching into trunk of a car, laundry dryer)

Question 32

What are some exercises to promote stepping strategy?

Answer 32

Standing sway with large sways, consciously taking step forward and backward Ambulate in tandem, promote balance steps Stepping over obstacle Walking on uneven surfaces Large rapid perturbations such that the hip strategy would be inadequate and stepping or reaching is required; progress from predictable to unpredictable disturbances

Question 33

What are the benefits of combined exercise programs?

Answer 33

Improve balance Improve mobility Reduce risk for falls